CRH expansion as emergency hospital for 653k people will abandon national standards for clinical rooms and wards

The Calderdale public and politicians mostly seem to have accepted NHS bosses’ proposal to turn Calderdale Royal Hospital into an acute and emergency hospital for both Calderdale and Kirklees, and send all Calderdale planned care patients (bar the riskiest ones) to a new planned care clinic in Huddersfield.

Do they realise what inadequate facilities are going to be provided for the huge increase in patient numbers that will result once Huddersfield Royal Hospital has been demolished?

Calderdale Councillors, MPs and residents who expect to see a major investment in facilities at CRH might well have missed a sentence tucked away on page 88 of the hospital Trust’s Full Business Case:

“The Plan assumes minimal change of existing buildings at CRH and an appropriate level of derogation to ensure compliance with the necessary statutory requirements.”

Alarm bells!!! What statutory requirements are they planning to derogate (abandon)?

In answer to a question about this at the recent Calderdale Health and Wellbeing Board meeting, Calderdale and Huddersfield NHS has now stated that:

Derogation forms part of the Business Case development and design process for capital investment schemes and is detailed in relevant NHSI guidance.

Wherever possible, architectural and building services/infrastructure should comply with the relevant HBN, HTM and statutory regulations. Where this is not possible, any such deviation should be agreed and signed off by the Project Director and/or Nurse/Medical Director in the case of major capital investment schemes, as part of the scheme of derogation.

Derogated standards must be identified and dealt with appropriately, the most common derogation in estates, in particular with refurbishment of existing estate, is reducing room size to less than the required m2. A quality impact assessment may be required to ensure that the derogation does not adversely affect the quality/safety of the patient/staff environment to ensure any risk issues are mitigated. In such circumstances derogation may be agreed if the consequences are identified, mitigated and managed.

HBN stands for ‘Hospital Building Notes’ which are national standards for the design and equipment of rooms used for clinical care. The idea that the Medical Director, or the Director of Nursing, on their own authority, could shrink the size of clinical rooms, is scary. In particular, you need to be able to have space for wheel chairs and trolleys, particularly if a patient collapses. There are no patient sitting rooms or dining rooms, so the only space they have is the little area around their beds. The closer you pack patients, the greater the risk of hospital-acquired infections.

HTM stands for ‘Health Technical Memoranda’ which are also a set of standards for the design and equipment of rooms in medical facilities, especially regarding ventilation and sterilization.

It is particularly awful that there are no patient sitting rooms. I thought clinicians were all supposed to be gung ho for getting patients out of bed these days, so they don’t lose all their muscle tone etc. It turns out the lack of sitting rooms is down to the Private Finance Initiative.

As with most PFIs, the cost was directly related to the floor area (or perhaps the volume of the building). Anyway, it meant that, back in 1998, when the new Calderdale Royal Hospital was being designed, all ‘soft’ space was removed from the design – that is any space that is not absolutely critical to patient care, like patient sitting rooms, patient dining rooms, staff sitting rooms and storage space for equipment and supplies. The capacity of the hospital, including out-patient space and A&E, was restricted to what was absolutely essential at the time, with no account taken of future increases in demand.

The lack of ‘soft space’ has hampered the hospital’s ability to meet demand in a way that would allow staff to work efficiently, because of space constraints preventing ergonomic design of work areas. This was a major problem on many wards and in busy areas such as the Eye Clinic. It also limits the ability to make best use of the work-force – there have been many times when a consultant had clinicians available, but no consulting rooms or operating theatres for them to work in.

The original design constraints mean that the current buildings are limited in their capacity to absorb patients displaced by the demolition of Huddersfield Royal Infirmary: the announcement in the Full Business Case that there would be minimal changes to the buildings at Calderdale Royal Hospital means that there would be no alternative apart from much greater care in the community.

It is not too late to take up the cudgels in defence of keeping both District General Hospitals each with their full type 1 blue light A&E department, which is what we need if we are all to have safe, timely and appropriate healthcare.

Tell your MPs, Councillors, friends, neighbours and colleagues, the Secretary of State for Health and the Independent Reconfiguration Panel that the current proposals are not fit for purpose and can’t be allowed to go ahead.

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